Healthcare Provider Details

I. General information

NPI: 1417972381
Provider Name (Legal Business Name): IMPERIAL MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16666 E JOHNSON DR SUITE # C
CITY OF INDUSTRY CA
91745-2412
US

IV. Provider business mailing address

16666 EAST JOHNSON DR SUITE # C
CITY OF INDUSTRY CA
91745-2412
US

V. Phone/Fax

Practice location:
  • Phone: 800-700-9565
  • Fax: 800-450-3718
Mailing address:
  • Phone: 800-700-9565
  • Fax: 800-450-3718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number101028
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number101028
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number101028
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number101028
License Number StateCA

VIII. Authorized Official

Name: MR. HOWARD M WEISS
Title or Position: CEO
Credential:
Phone: 800-700-9565